Georgia Form It-Qee-Sso2 - Qualified Education Expense Credit Reporting Form Page 2
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Georgia Form IT-QEE-SSO2
(Last Rev. 8/13)
Qualified Education Expense Credit Reporting Form
Georgia Department of Revenue
Such information as is required in (a) and (b) below is attached hereto:
CERTIFICATION BY STUDENT SCHOLARSHIP ORGANIZATION
The Student Scholarship Organization certifies that all information contained above and attached hereto is true to
their best knowledge and belief.
By: ____________________________________________________
Date:
Signature and Title of Authorized Officer
Name of Officer Signing
Phone Number
Instructions
This form is used to provide the following information to the Department of Revenue:
(a) O.C.G.A. § 20-2A-3 requires each student scholarship organization to report to the Department of Revenue
by January 12, for the prior calendar year:
(1)
The total number and dollar amount of individual contributions eligible for the credit and tax credits pre-approved.
(2 )
Total number and dollar amount of corporate and fiduciary contributions eligible for the credit and tax credits pre-
approved.
(3) Total number and dollar amount of scholarships awarded to eligible students; and
(4) A report listing the following information about each contribution received during the calendar year:
1. Name of the individual / entity.
2. Tax Identification Number (SSN for an individual; FEI Number for an Entity)
3. Address which includes:
a.
Street
b.
City
c.
State
d.
Zip
e.
Country if outside US
4. Actual contributed amount
5. Amount pre-approved by the Department of Revenue (on form IT-QEE-TP1)
(5) The total number of scholarship recipients who fall within each quartile of Georgia adjusted gross
income as defined and reported on the Georgia Department of Revenue’s website.
(6) Average number of dependents of families of scholarship recipients for each quartile of Georgia adjusted gross
income as defined and reported on the Georgia Department of Revenue’s website.
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